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This podcast provides a review of some of the key highlights from the Controversies in Modern Eye Care meeting held in April 2023. The program is designed for those who did not attend the live meeting and to help reinforce learnings for those who did.



 This transcript has been lightly edited for clarity.

At the present time, we really have no idea of what causes geographic atrophy, but a lot of attentions being played to the alternative pathway in the complement cascade, as everybody knows, there's three complement pathways. There's the classical, the lectin, and the alternative pathways. There is evidence drusen and in other histopath pathologies that there are complement factors that are involved in drusen, also in the pigment epithelium. There are certain complement changes that will potentially cause these changes to progress. So a lot of attention is being played in the alternative pathway. There is one drug, Annexon, that's being used in the classical pathway. It has some rationale because it's down-regulating C3, but from a different angle. C3 unfortunately, or fortunately, I guess, is the commonality of all three of the pathways, the alternative, classical, lectin pathway. But there is some evidence that C1q, which is found in the classical pathway, will have a role. It does play a role in synapses. It's also found on drusen.

Most of the work is being done in trying to reduce the alternative pathway from even starting. So down-regulation of the alternative pathway is the goal from almost all these drugs. If you start the alternative pathway and it goes through from C3 to C5, all the way to C9, you get what they call apoptosis. So the little cells at the edge of your atrophy begin to have holes, pores put into them, and the cells die. So by treating and trying to reduce the progression, we're hopefully going to reduce the apoptosis that occurs as the final event. So there are many different factors that are being looked at. We have factor I, factor B, factor D, all which down-regulate the complement system. Factor D happens to be a oral medication very similar to lampalizumab, which failed. We have factor I, which is a gene therapy that also down-regulates the system.

Factor B down-regulates the system. Well, there's also the ability to put in complement factor H that may be not present and some patients, and if they can do that, may slow it down. There's a new company that just started. There are some good factors that stop neovascularization from occurring on a genetic basis and they're being placed into the eye and hopefully can reduce progression. But the two major areas are inhibition of factor C3 and C5. C3 is a drug known by Apellis. This drug has been approved by the FDA and showed a fairly significant improvement in the extrafoveal geographic lesions. The extrafoveal lesions basically grow faster and they grow faster, and by reducing them, you can hopefully stop the lesions from growing into the center of the fovea and losing vision.

In fact, in their study, they showed about 27% reduction in these extrafoveal lesion growths, and they recently, just a few weeks ago at ARVO presented that if patients are 250 microns or greater from the center of the fovea, that those patients at two years had five letter better vision than they did in the group that was in the sham group that wasn't treated.

They also have shown that the lesions by visual field tend to not grow as much and you save off more retina. Lesions that are sub-foveal tend to grow at a slower rate in general, and it's only about a 16-18% reduction in the growth rate in that. There's no free lunch in medicine. There's always safety, which is the biggest concern that we have. We've had very excellent drugs recently for treating AMD, but because of the side effect profile and the safety, have never really been utilized to any great degree. The safety is good, but there was about 8% of patients that did go on to developing wet macular degeneration. Inflammation was about 1.5%. There's a small incidence of infection, but that goes along with almost every drug you put into the eye. The C5 is the next drug that will probably be approved.

It is basically, I think in July or August is their PDUFA date. So we'll know in July or August if the approval comes forward. But they should be approved. They have had two phase three trials that both showed statistically significant improvement, whereas in the Apellis drug, it took the C3 inhibitor, it did take 18 months before they started to show an improvement in one of the trials. And at 24 months, both trials were clinically and statistically significant. C5 is downstream from C3 and again, blocking it will decrease the ability for C5b to go on to activating the MAC complex at C9. Another drug that's being tested right now is CD59. It's a drug that actually, CD59 is a natural occurring protein that is in the eye. It goes up when you have AMD and if you can down-regulate that... I'm sorry, it goes down when you have goes down when you have wet AMD, and if you raise that, it will be a natural inhibitor of the progression.

It's a gene therapy. So one and done. Also has been shown to reduce progression of geographic atrophy, again, by the fact that it stops the progression to the MAC complex, it doesn't allow it to form, but we have a lot of unanswered questions. What starts the complement pathway? Is it amyloid? Because amyloid is found in drusen? Is that what stimulates and causes the pathway to begin? Do we have to treat forever? Can we treat just acutely and stop the process? How long do we have to do it? Is it forever? Is this something that we have to do forever? Or once you get the patient righted and you're not having any further inflammation in that pathway, can you back off? And would combination therapy be a more benefit? You've got a C3 inhibitor and a C5 inhibitor both showing about 27% decrease in the extrafoveal lesions.

If you put them together, would that equal an improvement? If you added C3 to CD59, would that cause a bigger improvement? And those are things that'll have to be worked out in the future. Certainly, gene therapy or longer-acting delivery systems are going to be the answer to this. It's not very sustainable to give monthly or even every other month injections to these patients. And the other thing that I'm really amazed about is the number of patients who have dry AMD. When you look at autofluorescence or look at their OCTs or look at their photographs, have geographic atrophy present. It's a lot larger population than I originally thought.

So first, you can have direct damage, which is through the membrane attack complex, which directly targets the RPE cells, and you can also have the indirect damage, which is to the photoreceptor cells where you get that abnormal protein deposition, which directly leads to the mortality of photoreceptor cells.

Evidence supporting the contribution of the complement system to progression of AMD and GA has accelerated the development of therapeutics targeting complement protein C3 and C5. Drugs being investigated include avacincaptad pegol, which inhibits C5 and C5 cleavage, pegcetacoplan, which prevents C3 activation, ANX007, which inhibits C1q, and GEM 103, which controls the complement cascade. Let's listen to Dr. Boyer review these agents.

At the present time there are a number of companies that are investigating the complement pathway as a means of slowing down the progression of geographic atrophy. The thought being that the geographic atrophy occurs and progresses due to dysregulation of the complement system. We don't know what starts it. We don't know if it's started by amyloid, oxidative stress can start this, but there are a variety of different causes that activate the complement pathway. Why the complement pathway? Because a lot of complement factors that are being investigated are found within drusen, and drusen are a hallmark of dry macular degeneration. We also can see that complement factors that are involved in genetics also play a major role.

So if we go to the GATHER 1, 2 trial, which is a C5 inhibitor, basically at this time it's PDUFA date or the day that the FDA has to announce whether they'll allow us to use it or not or approve it is in late July, early August, and it probably will be approved because they've had two 12 month phase three trials that both showed an improvement. In this trial the patients had have to have extra fovea lesions, meaning that the area of geographic atrophy was not centered and was not under the center of the fovea. It could be one micron away, but that was considered non-central involvement. And in that case, in the first GATHER 1 trial, there were about a 27% reduction in progression. In the GATHER 2 trial, it was much more modest, about 16 to 18% reduction.

They were both statistically significant. And when you looked at the GATHER 1 trial data over a long period of time, 18 months, that held, and we don't have the long-term GATHER 2 data. In the second year of the GATHER 2 trial, 50% of the patients went to every other month, and some continued on a monthly basis. Now, there are other differences between the trials, but the safety of the C5 inhibitor was excellent. They had no signs of uveitis. They had a very small incidence of conversion to wet macular degeneration, about 6%.

They seem to have excellent response. They've showed a reduction in the three line loss of vision by patients being treated over the period of time. So we don't have that drug available yet, but at least for non subfoveal lesions, extrafoveal lesions, this appears to be a good alternative. The drug that has been approved recently is a C3 inhibitor by a company called Apellis. It's called SYFOVRE. And this drug acts within the complement system and is central to all the complement pathways. There are three complement pathways. There's the classical, the lectin, and the alternative, and they all meet at the C3 and then go on to C5. And the C3 blockage eliminates C3b from activating the alternative pathway and allowing it to not go to the MAC complex. They've done two trials, DERBY and OAKS. The OAKS trial was positive at 12 months showing an excellent reduction in vision.

The DERBY trial did not meet its primary specified endpoint, but at 18 months, both of them did, then at 24 months the results were excellent. For the extrafoveal lesions, which were about one third of all the lesions in their trial, they showed about a 27% reduction, very similar to the C5 inhibitor I just discussed. They also, however, had a very large percentage of patients who had the lesion under the foveal area, and those the results again, were positive compared to the sham and as well in growth. However, the growth rate was much less, in the range of about 16 17%. The growth rate was significantly decreased. In their trial again, the safety was good. There was slightly a higher incidence of inflammation, though the inflammation was mild and was treated with topical steroids. Also in addition to that, there was about an 8% risk of developing the wet MAC degeneration, having exudative form of Mac degeneration, that form.

There also had eight patients in the trial that went on to developing ischemic optic neuropathy, which seems to be a puzzle that nobody has been able to figure out. There was one patient, I think, in the GATHER trial, and there was one patient omalizumab, which was a very large trial. So this showed a definite change that's been investigated, and two neuro ophthalmologists that are world renowned could not find a correlation, and they found that all the patients had a disc at risk. They all had some other vascular episodes at a similar period of time, whether it be hypertensive crisis or some other change, and felt that this was based on that. But that is still something that needs to be discussed. There are several other complement factors that are being evaluated all again, to slow down the process of the alternative pathway. There's factor B, factor D, factor I.

There's patients who are receiving a CFH. There are also people that are now treating and trying to improve the genetics by giving proteins, or I'm sorry, giving the genes that are positive that actually can overcome the negative genes. There's one in the classical pathway called C1q that's being blocked that they feel is important. It plays a role in synapses and it's also found on drusen, so there is some reason to do it. By blocking it it does reduce C3 further down. Now, as you go down the complement pathway, you eventually end up at C9. And C9 is the MAC complex. It's composed of 5, 6, 7, 8, and 9, and it causes a pore formation, which causes cell to rupture and die. CD59 is a natural occurring protein that reduces the progression. It's found to be decreased in patients with macular degeneration.

And by gene therapy they can add CD59 as a protective mechanism. This protective mechanism may reduce the progression of the geographic atrophy and also reduce the progression of the wet MAC degeneration. So this also is being studied. There are a number of other drugs not in the complement pathway that are being studied to hopefully reduce the onset of the problem. One of them has to do with macrophages and trying to reduce the macrophages from becoming active and activating the complement pathway. Inflammasome are another substance that will cause the activation of the complement pathway and is being treated way upstream to hopefully stop the complement pathway from being activated. There are a number of other factors that are looked at. We know that our mitochondria go down as we get older, but in patients with macular degeneration, it goes down even more in the eye. So several companies are looking at treatment to try to improve the mitochondrial function over a period of time.

And as it improves the mitochondrial function, hopefully it will improve the low luminance vision, the poor vision that we get at night or just age related macular degeneration causes patients to have more difficulty with night vision. Reading needs more light. Driving at night is not very easy to do for patients with macular degeneration. So there are a number of other factors that are being evaluated to try to reduce the onset of the alternative pathway, and also to try to slow it down and hopefully in the near future, some combination of these will give us better results than we have today.

Visual loss associated with advanced GA affects many aspects of patients' lives. Daily functions like household chores become more challenging. Patients may engage in fewer social interactions and may be isolated from family and friends. Let's listen to Doctors Boyer and Macdonald discuss how GA affects patients' quality of life.

Geographic atrophy is an area of loss of the pigment as well as the photoreceptors that lie above them. So everywhere that you have an area of geographic atrophy, you actually have an area that's a blind spot or a scotoma. And obviously as a scotoma comes into the foveal area, patients lose the ability to read, drive, see people's faces clearly. Prior to that though, in both dry macular degeneration as well as wet macular degeneration, patients begin to have more difficulty with night vision. They have a lot more difficulty. They may come in to see you and they're 20/20, and the biggest complaint is, they can't read anymore. Doctor will say, well, you're 20/20. I gave you some reading spectacles, you should be able to read. The biggest problem is the loss of the ability to see. They need a lot more light and they have a hard time driving at night.

They don't feel comfortable driving at night. And even though their vision may be 20/20, their dark adaptation really suffers very early in the course of this condition and continues on. So it would be wonderful to have a drug that would improve that because that's the major complaint that I hear when I see the patients in the clinic. These patients come in and they've gotten the best spectacle correction possible, and sometimes they are 20/20, but still have bitter complaints about reading and everything.

I remember one patient specifically when I told them to buy a light that goes over their shoulder or to get a Kindle, and the patient with the light came back and said, I can read. I can read. It was like a miracle, just having more light and the Kindle has been a big boon. I think patients who want to read and try to read, the Kindle with back lighting is much better than a lot of the other machines that are out there to allow them to read. So I think that it really makes it very difficult for patients to drive and to see people's faces clearly. And again, depending on where the scotoma is, it can be devastating if it's in the center.

It affects it drastically. First, you can have direct decrease of vision. So the visual impairment can affect everything that would require detailed vision. So reading, self-care, detailed vision. And it can also affect contrast sensitivity, which is being able to see shades of gray. So looking at something that wasn't high contrast, very black on white, for instance, looking at facial features of somebody or expressions or navigating in dimmer illumination. So this can lead to a decrease in self-care and activities of daily living, which then can make somebody feel like they are more dependent on others, and that can directly lead to decreased social interaction for people. And decreased social interaction is obviously going to lead to an impact on mental health for these individuals. So it affects them very severely.

Low vision aids and vision rehabilitation services may be especially helpful for patients with GA. Among individuals with low vision, an estimated 90% have useful residual vision that could be optimized from rehabilitation services. Many patients are unaware that these low vision services are available. Doctors Boyer and Mac Donald outline these services.

I think one of the things that we as physicians and eyecare professionals in general, really don't pay enough attention to is the wonderful advances that have been made in low vision. It's very frustrating for me as a doctor for many, many, many years to not have a treatment available for these patients, many of which are very active and except for their dry macular degeneration, geographic atrophy, really want to do things that are in good health. They want to travel, they want to do whatever they can. Some of them are professors and they like to read and they want to continue reading. So I refer a fairly large number of patients to low vision specialists because there are a lot of devices out there, and there are more to come. There are a lot of devices, unfortunately are very expensive, but there'll be glasses that will magnify and will be able to help them read, be able to read to them if they can't read.

There are certain devices that can actually read to them. You can take your iPhone and blow it up also. Just if you were shopping and you couldn't read a label, didn't know how much something costs, you can take a picture on your iPhone and just blow it up and be able to see what the price is so you don't go expecting a $15 item and it's $150 item. So I think that that low vision specialists really help the patients a lot. They teach them little tricks. In the home what they can do, they teach them about navigation. You won't see very many of the patients come in with a white cane, even though they may be legally blind from macular degeneration. It just doesn't happen in my experience. So they have to be very careful when they're outside. My mother, as I indicated earlier in the conversation, had severe macular degeneration, and I took her to a wedding.

My wife was out of town. My sisters were going somewhere else, and I realized that just going down an escalator was difficult for her because she couldn't see where it started and where it ended. Going to the restroom, everybody's got fancy restrooms, little things that sometimes I have to look three times to make sure I'm going into the correct one because the little models that they have on the door are sometimes questionable when I look at them for a while. So I think that there's so many things that low vision can help, just extra lighting. When you go to read a menu, they'll be embarrassed to pull it out. But I send a lot of patients to get low vision, and I think the low vision devices in the very near future will improve greatly.

So when somebody has a vision loss, supplementing that by going to a low vision specialist, looking at what your vision is and how much magnification you need or filters or lighting to help somebody improve their quality of life and daily living tasks is important. A low vision doctor will look at various assistive technology devices or regular optical devices to assist somebody, and they may even do specific training for the patient and have adaptive strategies for them, as well as being able to coordinate with all the other eyecare professionals and other interdisciplinary professionals to help the patient navigate this condition.

This podcast provides a review of some of the key highlights from the Controversies in Modern Eye Care meeting held in April 2023. The program is designed for those who did not attend the live meeting and to help reinforce learnings for those who did.

Advances in treatment for geographic atrophy

The optometrist’s role in managing age-related macular degeneration with OCT-A

The first 6 patients in the study had an average improvement of 14.9 letters in early treatment diabetic retinopathy study (ETDRS) standard vision tests within 4 to 6 months post transplantation.

Eyestem Research's phase 1/2a trial results find significant vision improvements in patients treated with Eyecyte-RPE for GA

Rachelle Lin, OD, MS, FAAO, and Quan Đông Nguyễn, MD, MSc, presented available treatment options and what is coming down the pipeline for retinal conditions. 

CRU 2025: The latest in treatments for DR, nAMD, and GA

Results from a recent study led researchers to advise clinicians of the potential for dystrophies that mimic age-related macular degeneration and other atrophic macular pathologies to be incorrectly diagnosed, which can impact treatment.

Researchers highlight the risk of misdiagnosing geographic atrophy

This follows successful Phase 1 results, which demonstrated a favorable safety profile for BI 771716 across both single and multiple intravitreal doses.

CDR-Life completes fifth milestone and is recruiting patients for Phase 2 study of BI 771716

Alongside Rachelle Lin, OD, MS, FAAO, Nguyễn, MD, MSc, detailed what treatments are currently available for retinal vascular diseases, including neovascular age-related macular degeneration and diabetic retinopathy.

A retinal roundup with Dr. Quan Đông Nguyễn

At the 2025 CRU meeting in Napa, California, Quan Đông Nguyễn, MD, MSc discussed recent developments in retinal diseases, focusing on diabetic retinopathy, macular edema, geographic atrophy, and neovascular age-related macular degeneration (nAMD). He highlighted the availability of new medical therapies and the benefits and risks of anti-complement therapies for geographic atrophy. The discussion also covered the ineffectiveness of adding VEGF-C and -D blockers in neovascular AMD treatments. The session emphasized early treatment, the importance of collaboration between ophthalmology and optometry, and the potential of growth factor therapies like ciliary neurotrophic factor for macular telangiectasia.

Editor's note: The below transcript has been lightly edited for clarity.

Hi, I'm Quan Đông Nguyễn, currently professor of ophthalmology, Medicine and Pediatrics at the Byers Eye Institute and at Stanford University School of Medicine in Palo Alto. Certainly, it's great pleasure to be back here at the 2025 CRU meeting here in Napa. Yesterday, we were discussing about the various developments and investments in the field of retina, especially medical retina aspect as well as inherited retinal disease. So I had a wonderful time sharing with our colleagues some of the developments we have. The session covered 4 different parts, starting out with diabetic retinopathy, diabetic macular edema, then followed by geographic atrophy, and followed by neovascular AMD, and finished up with a session on treatment of different aspect of the disease and the treatment, the last aspect we covered, was macular telangiectasia. So during that 1-hour discussion, we went over many different aspects. Certainly, we talked about some of the latest developments, availability of medical therapy in medical retina, for example, with the availability of flotetuzumab, with the availability of the high dose of aflibercept, 8 milligram. Then we talked about how we can use them, when to apply them, when to switch, when to do certain things. 

Subsequently, we talked about geographic atrophy. Currently we have 2 different availability drug that we use for treatment of geographic atrophy: anti-complement 3 and anti-commitment 5. And so we discussed about the potential goods and benefits of both of them, knowing that even though they do not stop the growth of the disease, of the geographic atrophy, but they certainly can slow down. And so we talk about the risk and benefit for that. 

Then we move over to neovascular AMD, where we were able to look at different regimen, different study. Again, based on the development of that, we learned that it is very important to treat, certainly using anti-VEGF therapy, but also perhaps to consider other aspects. We learned that the addition of blockage of VEGF-C and D may not make a difference, given the result of the recent costudy that failed to show that addition of anti-VEGF-C and D make any difference for that in that aspect. So we learned about upcoming trials that may be helping to reset the goal for our patient with retinal vascular diseases like diabetic retinopathy and macular degeneration. 

Then we all finished the session about treatment for macular telangiectasia, showing that how the ciliary growth factor has been able to improve of that concept. So the CNTF treatment, ciliary neurotrophic factor, have been very helpful, and the trial positive, and it's recently been approved. So we look forward on perhaps consider managing outpatient with that condition with the latest treatment. So overall, the session was quite exciting. I was very pleased to be able to share our knowledge with our colleagues in both ophthalmology, as well teaching, educating some our colleague in optometry as well, some of the latest development we have.

One of the concepts that come out recently is that disease should be treated early and not waiting for end stages. So I think the collaboration between the 2 fields of ophthalmology and optometry is extremely important. Certainly, there's limited number of ophthalmologists, especially retina specialists, so therefore, many of our patients are being evaluated locally in different small cities, for example, by our colleagues in optometry. It would be very good to alert the patient, alert yourself also too, that disease can come or can reoccur unexpectedly. And we have learned from many of these trials that it is better to treat early and treat appropriately. So delay treatment may not be good, so it's very good that we could detect early and perhaps the optometrists can then send to the appropriate colleagues in retina, for example, to help out.

Alongside Rachelle Lin, OD, MS, FAAO; Nguyễn, MD, MSc, detailed what treatments are currently available for retinal vascular diseases, including neovascular age-related macular degeneration and diabetic retinopathy.

Conference

CRU 2025: A retinal roundup with Dr. Quan Đông Nguyễn

Sherrol Reynolds, OD, FAAO, values the ophthalmic-optometric collaboration on display at the summit, running from February 14-17, 2025 in San Juan, Puerto Rico.

EnVision Summit 2025: The latest in retina discussion on the books

Sharrol Reynolds, OD, FAAO, a professor at Nova Southeastern University College of Optometry, discusses her anticipation for the upcoming EnVision Summit in San Juan, Puerto Rico, from February 14-17, 2025. The summit, unique for its collaboration between ophthalmology and optometry, will feature the latest research and treatments in retina, including geographic atrophy and age-related macular degeneration. Reynolds will present on these topics and participate in panels with esteemed retinal specialists. She encourages attendees to visit the summit's website for more information and to enjoy San Juan while gaining valuable eye care education.

Hello. My name is Dr Sherrol Reynolds, and I am a professor at Nova Southeastern University College of Optometry in Fort Lauderdale, Florida. I had the unique opportunity to be invited last year to the EnVision Summit in Puerto Rico, and what's unique about this summit is that it not only includes optometry, but it also includes ophthalmology. I think it's important that both professions address eye health need. And so it was a unique experience to be in a room with really smart and up to date information when it comes to ophthalmology and retina, but also to have optometry participate. So I look forward to this year's EnVision Summit. It's going to be again in Puerto Rico. The dates are February 14 through the 17, and it will be in San Juan, Puerto Rico. I have been invited again to present on the latest information when it comes to retina, new treatment when it comes to geographic atrophy, also talking about the latest research in retina, the latest update, the latest treatment modalities for our patients with retinal conditions, and to also be on panels with acclaimed experts in retinal specialists. So if you can, please go to the EnVision Summit website, and you can find out more information, the dates, and you can also register to come to San Juan Puerto Rico in February 14 through the 17th in 2025. I look forward to seeing you there.

Again, what's unique about the EnVision Summit is that it is a collaboration with ophthalmology and optometry, and that's what's unique about it. We're both working to address the latest information and updates in eye care, not just retina, but also glaucoma and anterior segment, the latest surgical updates. So it's good that both professions are coming together to address eye health needs.

So for me, I will be doing my presentation. I'll definitely be participating in all of the optometric content at EnVision Summit. But mine will be on retina and the latest, when it comes to age related macular degeneration as far as treatments, hot topics in retina, talking about the latest in pachychoroid, or the latest diagnostic modalities for retinal imaging, multimodal imaging, as well as the latest treatment. So in addition to getting great education, please come with family and friend and you can enjoy San Juan, Puerto Rico.

From new treatments on the horizon for macular degeneration to strengthening comanagement ties, optometrists cite a lot to be excited about in the coming year.

What's in store for optometrists in 2025?

Optometrists envision significant advancements in their field over the next 5 years. Key changes include embracing a medical eye care model, addressing patients' sports and recreational needs, increasing awareness of the profession's capabilities, and adopting light therapy for various conditions. They anticipate the development of new treatments like eye drops and oral medications for diseases such as diabetic retinopathy and macular degeneration. There is also excitement about artificial intelligence-enhanced retinal screening tools and a holistic approach to patient care, incorporating lifestyle factors like nutrition and exercise. Lastly, there is a push for better inter-referral systems and comanagement among optometrists and ophthalmologists to enhance patient care.

What change would you like to see in optometry within the next five years?

Yeah, it's a great question. There's probably plenty of things we all could think of from an optometry standpoint that we'd love to see change. I think, for me right now, it's starting to happen, and I hope it continues to evolve, which is just optometrists continue to embrace the medical eye care model, embracing the medical caring of patients. I think we're already doing that, but I want to see even get more and more involved, really. Because if you just look at the data, the stats around the sheer number of patients that are going to end up with ocular disease, glaucoma, macular degeneration, ocular surface disease, corneal conditions, it's just something that we have no choice. We have to embrace [it] to provide the best possible care for our patients. And we're doing a good job of it, but we can do a lot better, and I hope we continue to evolve in that way.

So in 2025 and in the next 5 years, I would like to see optometrists do more for their patients in terms of their sport and recreational pursuits. I think optometry is really good at addressing either academic or occupational needs of our patients, but often we neglect the sport recreation part of their life. I think it's a great way to connect with patients and provide them an added bonus to the care that we deliver, to be able to help them in that part of their life. It's often a part they're more passionate about.

There's a bunch of different things that could change. I feel like there'd be a laundry list or a wish list that if you ask that question to some other people, they'd just keep going and going. The only thing that really comes to my mind, off the top of my head, is just an increased awareness in our profession, our colleagues, what we can all do in terms of helping our patients. Whether that's fitting them with a contact lens to control myopia, whether it's diagnosing glaucoma, diagnosing an inherited retinal disease, helping a patient that's legally blind, whether it's our low vision friends, there's so many things that we can do. And I just feel like there should be more of awareness to, again, all the things that we can provide.

The biggest thing I'm excited about is light therapy for all kinds of conditions. We know we started out for dry eye disease. Now it's being approved for macular degeneration and advanced forms of it. So I am so excited about that, because that's something that we can own. We can own that space, and I can take care of those patients instead of having to speak to them, so that they have to go to a retinal specialist, wait a long time in that clinic, and we already have that established relationship. So with this new therapy, I am so excited for it. I'm also excited for what's on the horizon. A lot of talks have mentioned certainly eye drops or oral medications that can treat a lot of these conditions that we see a lot of patients with, such as diabetic retinopathy and macular degeneration. So yes, I'm very excited for what's on the horizon.

So what I would like to see change in optometry is looking at the patient as more of a whole person, and just not this set of eyeballs. So I would love to have more lifestyle interventions in our general practice, even in our primary care practice, not just specialties. I would love more to look at things like nutrition. I would love to look at exercise, stress, sleep, and just look at how all of those lifestyle factors are affecting our patients as a whole.

My main focus is usually retina stuff, so I think about more what's going on retina, but there's a couple new medications, perhaps, coming out for wet AMD, that I'm excited about. I think we, in a perfect world, we would get away from injections every month or every other month, so longer acting medications that will allow the retinal specialist to decrease the burden on the patient, I think is good. Also, there's some exciting technology coming out with AI in regards to retinal screening. There's a company – Optomed – that has a new camera. It's a handheld camera that uses AI to screen for diabetic retinopathy. So I think that's exciting, and it opens up opportunities, perhaps, for optometrists to get involved with that AI and involved in diabetic screenings. So I think that's exciting as well.

Something that I would like to see in optometry in 2025 and beyond, is the adoption [of] and pursuing medical optometry across all modalities of practice. I think one thing that we can learn from our ophthalmology partners is recognizing our peers who specialize in certain parts of optometry and create those interreferrals and trust that we can comanage patients together, so that if you have a special interest and your colleague has another, build those comanage patient referrals and build that trust within the families that hey, you know, I'm not the best person to manage a certain condition, but my colleague is. We've been working really hard on that in my area to create those referrals between optometrists, and it's been working really nicely to build not only the patient connection between both providers, but also I've really been appreciating the relationships that I now have with my other local optometrists. And I really enjoy not only the professional relationship, but the personal relationships that have built from that as well. So if you have a special interest in optometry, I encourage you to totally pursue it, connect with others, connect with mentors who have the same interests, and then connect with others who have different interests, so that we can maximize patient access to care. Because we as optometrist are on the front line to eye care, and patients deserve to be treated as soon as they need it, rather than having to wait for a referral when it's something that we as a profession could take care of.

What's in store for optometrists in 2025 and beyond?

EnVision Summit Co-chairs Sherrol Reynolds, OD, FAAO; Katie Rachon, OD, FAAO, Dipl ABO; Jessica Steen, OD, FAAO, Dipl ABO; and Cecelia Koetting, OD, FAAO, Dipl ABO; express excitement for the upcoming conference and why optometrists should attend.

EnVision Summit 2025: Meet the chairs

As the optometry track of the EnVision Summit expands in 2025, so does attendee excitement for the conference, to be held from February 14-17 in Puerto Rico. Conference optometry faculty Sherrol Reynolds, OD, FAAO; Katie Rachon, OD, FAAO, Dipl ABO; Ashley Wallace-Tucker, OD, FAAO, FSLS, Dipl ABO; Jessica Steen, OD, FAAO, Dipl ABO; and Cecelia Koetting, OD, FAAO, Dipl ABO; share what they find makes EnVision special and what they plan to take part in during the conference.

Hello. My name is Dr Sherrol Reynolds, and I am a professor at Nova Southeastern University College of Optometry in Fort Lauderdale, Florida. I look forward to this year's EnVision Summit. It's going to be again in Puerto Rico. The dates are February 14 through the 17th, and it'll be in San Juan, Puerto Rico. And I have been invited again to present on the latest information when it comes to retina, new treatment when it comes to geographic atrophy, also talking about the latest research in retina, the latest update, the latest treatment modalities for our patients with retinal conditions, and to also be on panels with acclaimed experts and retinal specialists. I look forward to seeing you there.

Hi. I'm Katie Rachon. I'm an optometrist at Virginia Eye Consultants in Norfolk, Virginia. We are a tertiary care, OD/MD medical only center. I am currently the residency director there for 2 residents. And I'm excited to be a speaker at the EnVision conference and attending the conference this year, because last year we had an amazing time, and the optometry track, we learned from a wide variety of colleagues from different settings. We learned from a lot of ophthalmologists that joined us during our track, so we could hear a lot about comanagement. And of course, this is all in a beautiful setting in Puerto Rico over the weekend. So I'm really excited to join again as a speaker and as an attendee, and I hope to see you there.

Ashley Wallace-Tucker, OD, FAAO, FSLS, Dipl ABO:

I think it's incredible that ophthalmology and optometry are coming together in this conference. I don't think I've ever had a learning experience quite like this. It's just great to have a collaborative approach to eye care. You know, we have a lot to offer each other as two professions that are different but aligned in the mission for the best eye health and eye care for our patients.

I'm looking forward to EnVision in 2025 to connect with colleagues, with optometrists, with ophthalmologists, with high level education in a panel format, and to really engage our full community, our family members, our colleagues' children, in a really unique and special environment.

I'm excited that we are getting to do this again this year, and hopefully maybe some more of our optometry friends will learn about the conference and come join us, not just for the optometry track. I mean, it's really encouraged that we're all at the same meeting, and if you want to go sit in on a session that's going on over on the ophthalmology track that interests you go over there as well, and vice versa.

EnVision Summit optometry faculty Sherrol Reynolds, OD, FAAO; Katie Rachon, OD, FAAO, Dipl ABO; Ashley Wallace-Tucker, OD, FAAO, FSLS, Dipl ABO; Jessica Steen, OD, FAAO, Dipl ABO; and Cecelia Koetting, OD, FAAO, Dipl ABO; express excitement for the upcoming conference and why optometrists should attend.

EnVision Summit 2025: Meet the faculty

A few optometrists share which innovations in optometry they were most excited about in 2024.

2024 in the rearview: What was the biggest development in optometry this year?

2024 was a year of innovation, both within and without optometry. Over the course of October and November, our editorial team asked optometrists what their favorite breakthrough of the year was. Themes included new dry eye therapies, a rapidly evolving technological landscape, novel treatments for geographic atrophy, and an emphasis on patient care. Here, key opinion leaders Carolyn Majcher, OD, FAAO; Melissa Barnett, OD, FAAO, FSLS; Julie Rodman, OD, MS, FAAO; David Geffen, OD, FAAO; Mila Ioussifova, OD, CNS, FAAO, FOWNS; and Nate Lighthizer, OD; share each of their favorite innovation from this year and how it has shaped the optometric landscape.

So the most exciting thing in optometry for 2024 I think, you know, the advent of new retinal therapies is a really, really exciting thing that's ongoing. So in 2023 we had approval of complement inhibition therapies for geographic atrophy. We're now emerging into the space of even some really novel, innovative therapies for neovascular wet AMD with like, subretinal injection delivery, genetic type of therapies. And then I had just met with LumiThera, and they had their like, photobiomodulation device just FDA approved, I think, like on Monday, actually. And so this is going to be the, like, a new type of therapy that we've never had before for macular degeneration. Optometrists are going to be able to do this in their office. And, you know, for patients that otherwise really had no options other than, like AREDS2 vitamin supplementation. So before neovascular disease, before center-involved GA, we're now going to have something to try to actually improve vision, not only just slow the progression of macular degeneration over time. So it's really exciting. Everything coming down the line for retina.


2024 has been an amazing year when it comes to the treatment of dry eye disease and ocular surface disease. We now have more products than ever before to really help our patients with the signs and symptoms of dry eye. So not only prescription medications, in-office procedures, looking at different ingredients and products, we have so much to offer our patients, and we can have more impactful conversations and more individualized care for our patients than we ever could before.


I think, from an academic standpoint, the fact that this profession is constantly changing, meaning that there are certain states in the country where optometrists can do some fantastic things, really is exciting. I think that you know, in the future, our scope of practice is going to continue [to expand], and there's just so much hope on the horizon. 

But my favorite advancement, or my thing that I've been most excited about is really the advancement in geographic atrophy. There's 2 new treatments. You know, this has been a condition that forever we've told our patients, sorry, you know you're going to go blind. Hopefully you'll outlive your disease, but eventually you're going to go blind. And so now we have 2 new options where patients can have somewhat of hope, somewhat, you know, thinking, well, maybe we'll be able to slow down the progression of this disease so that they'll be able to keep and maintain the vision that they have, be able to see their grandkids, be able to drive, be able to read. So I'm certainly excited about not only the advances in our scope of practice, but also in the therapeutic realm. Because every week, every year, your great stuff is coming; front of the eye, back of the eye. So that's what I love about optometry and about the eye field.


So I would say in the year 2024, the most impactful change that we've seen is the approval of several new dry eye pharmaceuticals. And I think this is going to change the whole face of how we treat dry eye. I think it's becoming a much bigger issue than what we've seen over the years, certainly more than when I got out of school, you know, 35, 40 years ago. So this is a huge change. I think it's going to be great. And I think doctors need to get on the bandwagon and start using these new drugs.


I know that so much has changed as far as technologies go. Maybe not just looking outside of like day-to-day, sort of technology that we do in our with our patients, like for diagnostics or treatments, and looking more on a broader [scale] like AI. I know there's softwares that are incorporating AI for in electronic medical records, or scribing and things like that, or even like in diagnostics, like for dry eye diagnosis and things like that. I personally haven't used that, but I know that's big, and it's probably going to be even bigger, I'm sure, and we're going to utilize them in all different aspects of our patient care. 

For me, I do utilize virtual assistants, so in my personal experience, in my practice, that's been one of the biggest things. That's really, we actually have 2 virtual assistants, and one of them is my scribe, and she's been with me for over a year now, and most of 2024, so that would be the the biggest thing that I've noticed in my efficiency and thorough notice of my charting; how much it's been, it's been a huge help. And also patient communication. So she really helps me stay on top of sending things to patients, communicating with patients. That's  been a game changer as far as how much time I'm saving and how thorough and comprehensive I am with my patient care.


In the past year, what I have found has been most impactful in optometry is the movement towards interventional dry eye management and interventional glaucoma management. What I mean by that is when we treat dry eye or treat glaucoma, and put all of the burden on the patient, whether it's dry eye drops, warm compresses, lid scrubs, or whether it's drop number one, drop number two, drop number three in glaucoma, that burden is on the patient to take their drops every single day to help to control their disease. I think we're seeing a movement into more interventional glaucoma and interventional dry eye, meaning SLT done earlier in glaucoma, MIGs, done earlier in glaucoma, drug delivery done earlier in glaucoma, along with intense pulse light therapy in-office, heat treatment to the meibomian glands in dry eye. So a mix and match of treatments, some on the patient for drops, but also in the hands of the doctors in-office to help ease that burden on patients.

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Dr. Carolyn Majcher emphasizes the importance of early diagnosis and setting clear expectations for preservation of vision for patients with GA

AAOpt 2024: Early detection and thorough imaging are the key to vision preservation in geographic atrophy

At the 2024 American Academy of Optometry meeting in Indianapolis, Indiana, Carolyn Majcher, OD, FAAO, describes optometrists' crucial role in the early identification and management of geographic atrophy (GA), an advanced form of age-related macular degeneration (AMD). Recent advancements in treatment, coupled with the importance of timely intervention, make it imperative that we equip ourselves with the necessary knowledge and tools to detect GA in its earliest stages. In a collaborative discussion with Steven Ferrucci, OD, FAAO, Majcher, a professor and director of residency programs at the Oklahoma College of Optometry, highlighted the significance of early detection and referral for patients with GA. 

Majcher emphasized that the newly approved intravitreal complement inhibitors, while not restorative, can effectively slow the progression of the disease, allowing patients to maintain their vision and quality of life for longer. The key, as Majcher explained, is to identify high-risk patients and initiate a comprehensive imaging protocol. Patients with large-sized drusen and pigmentary changes are at an increased risk of developing late-stage AMD, including GA. By utilizing multimodal imaging techniques, such as optical coherence tomography (OCT), fundus autofluorescence, and near-infrared reflectance, we can detect the early signs of GA before it invades the central fovea and significantly impacts vision. Majcher stressed the importance of not waiting for GA to progress to the point of visual impairment before referring patients to a retina specialist. 

Patients with extrafoveal or non-centered GA, typically at least one disc area in size, are ideal candidates for the newly approved intravitreal complement inhibitor therapies. These treatments, while not restorative, can slow the progression of the disease, preserving precious visual function and improving the patient's quality of life. 

Equally crucial is the need for patient education and setting realistic expectations. Patients must understand that the goal of these therapies is to slow the progression of GA, not to improve their vision. By managing their expectations and emphasizing the importance of regular monitoring and treatment, we can empower patients to be active participants in their care. As primary eye care providers, we have a responsibility to stay informed about the latest advancements in the management of GA. By mastering the techniques for early detection and establishing strong referral pathways, we can ensure that our patients with GA receive the timely and appropriate care they deserve, ultimately preserving their vision and enhancing their overall well-being.

Dr. Carolyn Majcher discusses her 2024 AAOpt talk on imaging techniques and emerging therapy for geographic atrophy.

Dr. David Chin Yee describes how to spot early signs of geographic atrophy and explores promising new therapies that may slow progression and improve vision.

EyeCon 2024: What optometrists need to know about geographic atrophy

At EyeCon 2024, David Chin Yee, MD, presented a talk entitled, "Geographic atrophy (GA): What every optometrist should know." In his presentation, Chin Yee discusses educating healthcare professionals on recognizing GA through imaging tools like fundus photography and OCT, highlighting symptoms such as decreased reading speed and difficulty in low light. It emphasizes the importance of early detection and frequent monitoring, recommending reevaluations every three months, and mentions emerging therapies targeting complement inhibition and gene therapy that may slow progression or potentially improve vision in the future.


Hi. I'm David Hutton of Ophthalmology Times. The Ophthalmology Times/Optometry Times EyeCon 2024 event is taking place at the Hilton Fort Lauderdale Marina on September 27 and 28, 2024, At the event, Dr. David Chin Yee presented "GA: What Every OD Should Know." Thank you so much for joining us. First, tell us about the key points of your presentation.


Thank you for having me. The key point is helping to kind of educate how to suspect the patients with geographic atrophy, what imaging modalities and tools are out there to kind of help to identify the findings that we would classically find ... going over and reviewing whether it's fundus photography, optical coherence tomography or OCT, or using fundus autofluorescence. One, again, to identify these lesions and also use it as a tool to educate patients on what the symptoms may appear as, and also be able to kind of educate the patients and what geographic atrophy actually is. We also briefly go over, you know, what geographic atrophy is and how quickly it progresses, making sure that it's understood that, unfortunately, it's a relentless, irreversible disease process that, thankfully now, for the first time, we have new treatment options which serve to slow down the progression, right. And it's important to understand, unfortunately, we don't have a way to reverse it. We're not stopping it. But the idea is, slowly, you know, to slow down the progression of this devastating disease process, which we now know as geographic atrophy.


What are the most critical signs and symptoms that ophthalmologists and optometrists alike should look for detecting the early stages of GA?


Yeah, you know, it's not similar in some of macular degeneration. What we look for, usually, is that the patient will note loss of central vision, specifically identified on the Snellen visual acuity. But patients with GA, a lot of times, they will notice findings a lot sooner. Specifically, their reading speed can be diminished, right. And so, a lot of our patients with macular degeneration, unfortunately, they also have difficulties with hearing and so they rely heavily on subtitles. And they will find that with the subtitles, their reading speed is decreased. So, they're not able to catch up and read the subtitles before they disappear. So that would be one finding. The other issue is difficulty in low light settings. So, their lights, low luminance or ability to read in low or dim lighting has been noted to be decreased, and that is also something that they will identify and notice. So, if they go to a nice restaurant, it's a candlelight dining, they will have the need to want to take out their flashlight or their phone to make it brighter for them to be able to read or see what they could have seen years prior before having this problem.


What role can optometrists play in monitoring disease progression in GA and how often should they be reevaluating patients?


Yes. So again, which we touched on, is having some of these findings or identifying these lesions, whether it be on OCT, or on fundus photo or fundus autofluorescence. These patients first need to be identified, know that they have this problem, and then be monitored a lot more frequently. Routinely, macular degeneration patients, we would follow up 6 months to once a year. Now, with patients having geographic atrophy, we like to tell them, see them at least every 3 months.


Are there any emerging therapies or technologies on the horizon for GA that both ophthalmologists and optometrists should keep their eyes on?


Yeah, thankfully, you know this is the first class of medication that we have focusing on complement inhibition to slow down the progression. But we do have other treatments — some that are going to be subcutaneous, some in the form of gene therapy — that look to be promising. And the hope is, with these newer treatment and technology, will be able to maybe stop or even reverse or improve vision in the future.

At EyeCon 2024, Dr. Adam S. Wenick led a symposium on geographic atrophy, covering diagnosis, FDA-approved treatments, and key clinician considerations through case presentations by Dr. Leonard Messner.

Geographic Atrophy

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